Innovative Management of Chronic Pain and Psychiatric Comorbidities

2020 ◽  
pp. 317-329
Author(s):  
J. Gregory Hobelmann ◽  
Michael R. Clark
Keyword(s):  
Chronic Pain ◽  
Functional Disability ◽  
Treatment Modalities ◽  
Physical Aspect ◽  
Psychiatric Comorbidities ◽  
Rehabilitation Programs ◽  
Innovative Management ◽  
Comprehensive Rehabilitation ◽  
Comprehensive Programs ◽  
Spiritual Suffering

Chronic debilitating pain causes physical, emotional, cognitive, and spiritual suffering. Chronic pain is frequently associated with psychiatric comorbidities, such as affective and anxiety disorders, further enhancing the suffering and functional disability of patients with pain. For much of the past three decades, treatment for pain has focused on the physical aspect of pain with little attention to emotional, cognitive, and spiritual maladies. We aim to describe comprehensive rehabilitation programs that take into consideration the entire patient. While the concept is not novel, comprehensive programs became nearly extinct for many years because of a variety of factors. Possibly the most innovative concept in pain medicine is the re-emergence of these programs, along with a variety of newer treatment modalities.

scholarly journals Opioid Induced Hyperalgesia, a Research Phenomenon or a Clinical Reality? Results of a Canadian Survey

2020 ◽  
Vol 10 (2) ◽  
pp. 27
Author(s):  
Grisell Vargas-Schaffer ◽  
Suzie Paquet ◽  
Andrée Neron ◽  
Jennifer Cogan
Keyword(s):  
Chronic Pain ◽  
Nmda Antagonist ◽  
Treatment Modalities ◽  
Clinical Test ◽  
Physician Practice ◽  
Clinical Tests ◽  
Opioid Rotation ◽  
Number Of Patients ◽  
Opioid Induced Hyperalgesia ◽  
Age Range

Background: Very little is known regarding the prevalence of opioid induced hyperalgesia (OIH) in day to day medical practice. The aim of this study was to evaluate the physician’s perception of the prevalence of OIH within their practice, and to assess the level of physician’s knowledge with respect to the identification and treatment of this problem. Methods: An electronic questionnaire was distributed to physicians who work in anesthesiology, chronic pain, and/or palliative care in Canada. Results: Of the 462 responses received, most were from male (69%) anesthesiologists (89.6%), in the age range of 36 to 64 years old (79.8%). In this study, the suspected prevalence of OIH using the average number of patients treated per year with opioids was 0.002% per patient per physician practice year for acute pain, and 0.01% per patient per physician practice year for chronic pain. Most physicians (70.2%) did not use clinical tests to help make a diagnosis of OIH. The treatment modalities most frequently used were the addition of an NMDA antagonist, combined with lowering the opioid doses and using opioid rotation. Conclusions: The perceived prevalence of OIH in clinical practice is a relatively rare phenomenon. Furthermore, more than half of physicians did not use a clinical test to confirm the diagnosis of OIH. The two main treatment modalities used were NMDA antagonists and opioid rotation. The criteria for the diagnosis of OIH still need to be accurately defined.

Assessment of Contributions to Disability in People with Schizophrenia during Rehabilitation

1993 ◽  
Vol 27 (4) ◽  
pp. 595-600 ◽  
Author(s):  
Russ O'connor ◽  
Helen Herrman
Keyword(s):  
Frontal Lobe ◽  
Emotional Distress ◽  
Global Assessment ◽  
Functional Disability ◽  
Positive Symptoms ◽  
Treatment Resistant ◽  
Rehabilitation Programs ◽  
Community Rehabilitation ◽  
Frontal Lobe Impairment ◽  
Community Rehabilitation Programs

The aim of this study was to assess a number of the components of disability in patients diagnosed with DSM-IIIR residual schizophrenia. Forty-one patients undergoing hospital and community rehabilitation programs were tested. A range of disability levels was defined with a measure of global assessment of function. A large proportion of the patients also had poor results on frontal lobe testing, persistent positive symptoms, and high levels of emotional distress. There was a trend for higher levels of positive symptoms to be associated with increases in global levels of disability, frontal lobe impairment and emotional distress. The work suggests that rehabilitation programs could be more focused if patients were assessed not only for their overall level of functional disability but also for the level of treatment resistant positive symptoms, frontal lobe impairment and the amount and type of emotional distress and insight.

Daily Physical Activity and Functional Disability Incidence in Community-Dwelling Older Adults with Chronic Pain: A Prospective Cohort Study

Pain Medicine ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. 1702-1710 ◽  
Author(s):  
Keitaro Makino ◽  
Sangyoon Lee ◽  
Sungchul Lee ◽  
Seongryu Bae ◽  
Songee Jung ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Chronic Pain ◽  
Functional Disability ◽  
Community Dwelling ◽  
Daily Physical Activity ◽  
Activity Duration ◽  
Intensity Physical Activity ◽  
Physical Activity Duration ◽  
Community Dwelling Older Adults

Abstract Objective This study examined the association between daily physical activity and functional disability incidence in community-dwelling older adults with chronic pain. Design Prospective cohort study. Setting Japanese community. Subjects Of the 5,257 participants enrolled for baseline assessment, data on the 693 participants who had chronic lower back or knee pain and underwent daily physical activity assessment using an accelerometer were analyzed. Methods Participants were assessed for regular physical activity (step counts, moderate- to vigorous-intensity physical activity duration, and light-intensity physical activity duration) using an accelerometer at baseline and were followed up for monthly functional disability incidence, based on the national long-term care insurance system, for approximately two years. We determined the effect of physical activity cutoff points on functional disability incidence using receiver operating characteristic curves and Youden index. Cox proportional hazards regression models were used to analyze associations between the cutoff points and disability incidence. Results Among the 693 participants with chronic pain, 69 (10.0%) developed functional disability during the follow-up period. Participants with lower physical activity levels showed significantly higher risk of disability. After adjusting for all covariates, functional disability was associated with step counts (hazard ratio [HR] = 1.79, 95% confidence interval [CI] = 1.02–3.14) and moderate- to vigorous-intensity physical activity duration (HR = 2.02, 95% CI = 1.16–3.51) but had no relationship with light-intensity physical activity duration (HR = 1.72, 95% CI = 0.97–3.05). Conclusions Maintenance of physical activity with at least moderate intensity may be effective in preventing disability even among older adults with chronic pain.

Social functioning in adulthood: Understanding long-term outcomes of adolescents with chronic pain/fatigue treated at inpatient rehabilitation programs

2016 ◽  
Vol 20 (7) ◽  
pp. 1121-1130 ◽  
Author(s):  
T. Westendorp ◽  
J.A. Verbunt ◽  
S.C. Remerie ◽  
A.C.E. de Blécourt ◽  
B. van Baalen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Social Functioning ◽  
Inpatient Rehabilitation ◽  
Long Term Outcomes ◽  
Rehabilitation Programs

scholarly journals Biomarkers of Allostatic Load as Correlates of Impairment in Youth with Chronic Pain: An Initial Investigation

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 709
Author(s):  
Sarah Nelson ◽  
Samantha Bento ◽  
Michelle Bosquet Enlow
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Allostatic Load ◽  
Functional Disability ◽  
Pain Treatment ◽  
Pediatric Pain ◽  
Childhood Experiences ◽  
High Exposure ◽  
Pediatric Chronic Pain ◽  
Study Results

Pediatric chronic pain is common and responsible for significant healthcare burden. However, the mechanisms underlying the development and/or maintenance of pediatric chronic pain remain poorly understood. Allostatic load (AL), or wear and tear on the nervous system following significant or prolonged stress, has been proposed to play a role in the maintenance of chronic pain, but minimal research has examined this possibility. This gap in research is particularly notable given the high exposure to adverse childhood experiences (ACEs; abuse/neglect, etc.) and psychological stress in this population. Accordingly, the current study aimed to preliminarily examine the measurement of AL in a treatment-seeking pediatric pain population. Biomarkers were collected during an already scheduled new patient pain evaluation and included salivary cortisol, dehydroepiandrosterone (DHEA), and C-reactive protein, in addition to waist–hip ratio, body-mass index, and blood pressure. A total of 61 children and adolescents with chronic pain (Mage = 14.47 years; 88.5% female and white/Caucasian) completed study procedures and were included in analyses. Preliminary results indicated that a multifactorial AL composite is feasible to assess for in a tertiary pain treatment setting and that over 50% of youth with chronic pain were classified as high risk for AL (two or more risk factors). Further, it was found that individual AL risk factors were significantly associated with functional disability and that AL may moderate the association between psychosocial and functional outcomes. Given the pilot nature of this study, results should be used to inform future investigations with larger and more diverse pediatric pain samples.

scholarly journals Management of Palmo-Plantar Psoriasis by Classical Shodhan and Shaman Chikitsa- A Case Report

2021 ◽  
Vol 12 (1) ◽  
pp. 166-170
Author(s):  
Anagha S Hirapure ◽  
Saurabh Deshmukh ◽  
Trupti Thakre
Keyword(s):  
Mental Health ◽  
Case Report ◽  
Severe Pain ◽  
Functional Disability ◽  
Skin Diseases ◽  
Lifestyle Modification ◽  
Skin Condition ◽  
Treatment Modalities ◽  
Specific Line

Background: Palmo-plantar psoriasis in a non-inflammatory skin condition in which it is capable to produce functional disability. It is the type of psoriasis which occurs in palms and soles together with features like scaling, erythema and itching, pustules cracked & pain, and is limited. Palmo-plantar is the disease which does not have a specific line of treatment, but can be assessed and treated with classical line of Ayurvedic management. This Palmo-plantar not only affects physically but also disturbs the mental health of patient In Ayurveda all the skin diseases are described under single topic; Kushtha (Skin disorders). As Palmo-Plantar psoriasis is compared with Vipadika Kshudra Kushta (cracked bilateral soles & palms) in Ayurveda, the predominant Dosha’s (fundamental bodily bio-elements) are Vata (governs movement of body & mind) & Kapha (controls immune system) in which Vaman Karma (Emesis) is useful. Aim: To evaluate the role of Ayurveda treatment modalities in Vipadika Kshudra Kushta. Materials & Methods: A case report of 56 year old male patient suffering from scaling of both palms and soles with severe pain since 16 years is presented in this article where the patient got satisfactory relief by adopting Shodhan Karma (purification treatment) followed by Shaman Chikitsa (pacifying treatment) with dietary and behavioral lifestyle modification. The symptoms were reduced by Vaman procedure. Result: Patient got about 80% relief after the treatment by which one can say that the palmo-plantar psoriasis can be treated by Ayurveda Medicine.

scholarly journals TO EVALUATE THE EFFECT OF UPANAHA SWEDA IN JANUSANDHIGATA VATA WITH VACHADI AND KOLADI YOGAS A COMPARATIVE CLINICAL STUDY

2021 ◽  
Vol 9 (8) ◽  
pp. 1675-1682
Author(s):  
Desai Sucheta ◽  
Desai Ananta ◽  
Borannavar Shaila
Keyword(s):  
Clinical Study ◽  
Elderly Population ◽  
Functional Disability ◽  
Signs And Symptoms ◽  
Walking Distance ◽  
Treatment Modalities ◽  
Age Factor ◽  
Comparative Clinical Study ◽  
Group A

The present scenario of lifestyle is prone to cause many lives deteriorating conditions. Sandhigatavata is one among the Vatavyadhi and the commonest articular disorder affecting the middle-aged, obese, and elderly population. The advancement in working pattern, lifestyle & age-factor, all together have become a prime cause for aggravation of Vata, which accelerates Dhatukshaya (depletion of tissues). Sandhigatavata can be correlated with osteoarthritis (OA) which is one such chronic, degenerative, inflammatory disease that has a great impact on the quality of the life of an individual. OA poses a huge hindrance in the day-to-day activities of the sufferer like walking, dressing, bathing etc. As per Ayurveda, it is caused due to localized accumulation of aggravated Vata in joints, which leads to Shula, Sotha, Vatapoornadritisparsha and functional disability of affected Sandhis. If not treated in time, the disease makes man disable. According to epidemiology the prevalence of osteoarthritis in India is 22-39%. Different treatment modalities like Snehana, Swedana, Lepa, Bandhana, Agni Karma and Raktamokshana are emphasized in Ayurveda to provide better relief from the pain and swelling and restore mobility; for the management of these symptoms, Swedana is the most convenient & best procedure. So, the present study was aimed to assess clinically the effect of Upanaha Swedas in the management of Janusandhigatavata. Objectives: To evaluate and compare the efficacy of Vachadi Upanaha Sweda and Koladi Upanaha Sweda in the management of Janusandhigatavata. Materials and Methods: It was a randomized comparative clinical study; total 40 patients were divided into 2 groups as 20 in each. In Group A, patients were treated with only Vachadi Upanaha Sweda and other group patients were treated with Koladi Upanaha Sweda. Results: Statistical analysis revealed that both the interventions wereeffective in reducing all the signs and symptoms of Janusandhigatavata, however in parameters Shotha, tenderness and walking distance, Koladi Upanaha Sweda showed better response than Vachadi Upanaha Sweda. Conclusion: There is a significant effect of Koladi Upanaha Sweda over Vachadi Upanaha Sweda in Janusandhigatavata both clinically and statistically. Keywords: Janusandhigatavata, knee osteoarthritis, Koladi Upanaha, Vachadi Upanaha, Swedana.

Parental Perceptions of Pediatric Pain and POTS-Related Disability

2016 ◽  
Vol 56 (13) ◽  
pp. 1185-1192 ◽  
Author(s):  
Elizabeth M. Keating ◽  
Ryan M. Antiel ◽  
Karen E. Weiss ◽  
Dustin Wallace ◽  
Seth J. Antiel ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Functional Impairment ◽  
Functional Disability ◽  
Clinical Symptoms ◽  
Health Condition ◽  
Pain Clinic ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Parental Attributions ◽  
Attribution Questionnaire ◽  
Chronic Pain Clinic

Adolescents with postural orthostatic tachycardia syndrome (POTS) often have pain and functional impairment. This study evaluated how parental attributions of children’s symptoms relate to child functional impairment. Adolescents with chronic pain and clinical symptoms suggestive of autonomic dysfunction (fatigue, dizziness, nausea) that attended a multidisciplinary chronic pain clinic completed measures of depression, anxiety, and functioning (n = 141). Parents of 114 of these patients completed the Parent Pain Attribution Questionnaire (PPAQ), a measure indicating the extent they believe physical and psychosocial factors account for their child’s health condition. Patients were retrospectively grouped as to whether or not they had significant POTS on tilt table testing (n = 37). Greater parental attribution to physical causes was associated with increased levels of functional disability whether patients had POTS ( r = 0.45, P = .006) or not ( r = 0.25, P = .03). These results suggest that providers should advocate a more comprehensive family-oriented rehabilitative approach to treatment.

Psychiatric comorbidities among individuals with HIV and chronic pain

2016 ◽  
pp. 71-77
Author(s):  
Durga Roy ◽  
C. Brendan Clark ◽  
Glenn Treisman
Keyword(s):  
Chronic Pain ◽  
Psychiatric Comorbidities

Quality of Life and Well-Being of Breast Cancer Patients

2020 ◽  
pp. 67-94
Author(s):  
Melisa Anderson ◽  
Dwayne Tucker ◽  
Fabian G. Miller ◽  
Kurt Vaz ◽  
Lennox Anderson-Jackson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patients ◽  
Negative Impact ◽  
Well Being ◽  
Treatment Modalities ◽  
Physical Aspect ◽  
Breast Cancer Patients ◽  
Malignant Breast

Breast cancer is a disease in which there is increased proliferation of malignant breast cells. This disease is more likely to begin in the ducts or lobules rather than the connective tissue. Globally, breast cancer is the most regularly diagnosed cancer. It is also a leading cause of cancer-related mortality in females. While cancer of the breast affects the physical aspect of patients, it can also negatively impact the quality of life (QoL) of survivors. There is a dearth of information, especially in the last decade, on the negative impact of breast cancer and treatment modalities on the QoL of patients. This review of the literature will examine the QoL and well-being of breast cancer patients to present a current perspective on the topic. Major findings of past and present articles that have contributed to improving the care of breast cancer patients will be summarized and included.

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